Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: The ASAS/EULAR recommendations for the management of patients (pts) with axial spondyloarthritis (axSpA) have established non-steroidal anti-inflammatory agents (NSAIDs) as first choice of medical treatment in this condition. However, the outcome of this strategy has not been prospectively tested to date. Standardized measures (BASDAI, ASDAS) are routinely used to assess disease activity in pts with axSpA. Both measures are composite scores but only the ASDAS also includes CRP values as an objective measure. However, a direct comparison between ASDAS and BASDAI in axSpA pts treated with NSAIDs in a prospective study has not been performed to date. We prospectively compared the performance of BASDAI and ASDAS to identify candidates for anti-TNF therapy among patients with axSpA with high disease activity who were treated with full-dose NSAIDs over 4 weeks, as suggested in the ASAS treatment recommendations.
Methods: Consecutive patients (pts) with axSpA (both n=50 for nr-axSpA and AS, respectively) were included in a prospective study if their BASDAI level was ≥4, and if they had not received the maximally approved dose of NSAIDs nor anti-TNF agents to date. After inclusion into the study the maximal dose of NSAIDs was administered over 1wk and the dose was then adapted in case of BASDAI<4. In case of BASDAI ≥4 of in case of NSAID intolerance, the NSAID was changed and the pt was treated for another 3 wk at the maximal dose. Clinical and laboratory parameters and dosage of drugs were assessed by using the ASAS NSAID-index. Data were collected before (BL) and after 1 and 4 wk of treatment.
Results: The baseline (BL) characteristics of AS and nr-axSpA patients were similar, with exception in the mean CRP levels (nr-axSpA: 0.6±0.9 vs. AS: 1.2±1.1, p<0.001). Despite all patients having BASDAI ≥4 prior to treatment, an ASDAS >2.1 was found in only 74% and 76% of pts with AS and nr-axSpA, respectively. There was a significant overall decrease at both timepoints in both ASDAS-CRP (BL: 2.5±0.6, 1wk: 1.9±0.8, 4wk: 1.6±0.8) and BASDAI (BL: 5.8±1.3 1wk: 4.1±2.1 4wk: 2.1±3.1). After 4 weeks of standardized treatment with NSAIDs, there were 44% of all axSpA pts with a BASDAI ≥4 (AS 42% und % nr-axSpA 46%), while 33% of all axSpA pts (AS 32% and nr-axSpA 34%) had an ASDAS > 2.1. Overall, the two scores were in agreement in 81%. In 15% of pts, the BASDAI score would have possibly led to treatment with TNF blockers – despite an ASDAS <2.1, and, on the other hand, in 4% of cases the ASDAS would have initiated anti-TNF treatment but the not the BASDAI. In the univariate logistic regression analysis both, ASDAS (OR: 3.6, p=0.002) and BASDAI (OR: 1.8, p=0.001) predicted the eligibility for anti-TNF therapy after 4wk of NSAIDs at BL.
Conclusion: These data challenge the concept of only using the BASDAI cut-off ≥4 for the treatment decisions of initiation of TNF-blocker therapy. The question on whether BASDAI or ASDAS should be used as the appropriate cut-off for such treatment needs to also include the comparison of the subjective information on disease activity with CRP and MRI data and by assessing the predictive value of the response to NSAIDs for the response to TNF blockers in future studies.
Disclosure:
X. Baraliakos,
None;
U. Kiltz,
None;
F. Heldmann,
None;
H. Appel,
None;
F. Dybowski,
None;
M. Igelmann,
None;
L. Kalthoff,
None;
D. Krause,
None;
H. J. Menne,
None;
E. Saracbasi,
None;
E. Schmitz-Bortz,
None;
J. Braun,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/different-performance-of-the-major-disease-activity-measures-asdas-and-basdai-in-patients-with-axial-spondyloarthritis-treated-with-non-steroidal-anti-inflammatory-agents-results-from-a-pros/